Two types of surgery are used to treat esophageal cancer—endoscopic mucosal resection (EMR) and minimally invasive esophagectomy.
Endoscopic Mucosal Resection (EMR) and BARRX Balloon Ablation
The BARRX Halo Ablation Catheter delivers a short burst of ablative energy circumferentially to the esophagus (balloon length: 4 cm).
Patients with very early cancers of the esophagus can be treated without extensive surgery by a combination of minimally invasive techniques. In Endoscopic mucosal resection (EMR), the portion of the lining that is diseased is removed using an endoscopic procedure. EMR enables the endoscopist to take a sample of tissue for biopsy at the same time as it is being removed. BARRX ablation is a very specific type of ablation, in which heat energy is delivered in a precise and highly controlled manner. In patients who are operative risks, these techniques can be incorporated to open up esophageal blockages or treat small tumors endoscopically.
Stents may also be used to enable patients with esophageal blockages to swallow. Laparoscopic esophagectomyto remove a diseased lower esophagus is becoming an alternative procedure to the more traditional surgical methods, especially in early-stage esophageal cancers. These and other techniques of esophageal cancer resection pioneered at Columbia result in some of the highest cure rates ever reported.
We perform many of our esophageal resections for cancer using laparoscopy or thoracoscopy. These minimally invasive approaches can significantly reduce the post operative convalescence, and speed recovery. Not all patients are candidates for minimally invasive approaches, but our considerable experience with open surgery enables us to select appropriate patients for minimally invasive procedures.
Minimally Invasive Esophagectomy (MIE)
NewYork-Presbyterian/Columbia surgeons are pioneers in Minimally Invasive Esophagectomy (MIE) and train surgeons around the world in MIE techniques. Our program uses MIE for 80 percent of esophageal procedures. Just as in open surgery for esophageal cancer, MIE involves removal of the esophagus and lymph nodes.
In all esophagectomy procedures, the surgeon makes an incision in the abdomen, separates the esophagus from the stomach, and utilizes a portion of the stomach to fashion a replacement esophagus. The remaining portion of the stomach retains its normal function. Additional incisions are made in the chest and/or neck, depending upon the portion of the esophagus that is diseased, as well as the patient's anatomy:
• Trans-hiatal esophagectomy (THE) involves an incision in the abdomen as well as the neck. THE is generally performed for early-stage cancers, and is routinely done minimally invasively.
• Ivor Lewis esophagectomy (also known as trans-thoracic esophagectomy, or TT) involves an incision in the abdomen as well as the chest. This procedure is employed when the tumor or cancerous tissues are located in the upper part of the esophagus.
• A three-incision option involves access to the abdomen, the chest, and the neck.We perform all of these procedures using minimally invasive approach, although open surgery may be more appropriate depending upon the patient's clinical characteristics and the location of the diseased portion of the esophagus.
Patients should only have an esophagectomy performed by a specially trained thoracic or general surgeon highly skilled in this procedure.
More information can be found here http://www.columbiasurgery.org/esophageal/esophagectomy.html